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Detection of preinvasive cancer of the cervix and the subsequent reduction in invasive cancer.
Bergstrom R, Adami HO, Gustafsson L, Ponten J, Sparen P.
J Natl Cancer Inst 1993 Jul 7;85(13):1050-7.The results of this study show that there is no association, or at most the association is weak, between the detection of in situ (pre-invasive) cervical cancer through Pap-smear screening and the subsequent reduction on the incidence of invasive cervical cancer. These results imply that early diagnosis of in situ cervical cancer may lead to unnecessary extensive treatment of lesions that would otherwise resolve spontaneously.
International incidence rates of invasive cervical cancer after introduction of cytological screening.
Gustafsson L, Ponten J, Zack M, Adami HO.
Cancer Causes Control 1997 Sep;8(5):755-63.The results of this study show that the incidence of cervical cancer in populations who have organized national cervical cancer screening programs is similar to that of populations with opportunistic screening, indicating that organized screening of a large segment of the population is not superior to opportunistic screening in reducing cervical cancer rates.
Why do we continue to take unnecessary smears?
Woodman CB, Richardson J, Spence M.
Br J Gen Pract 1997 Oct;47(423):645-6.This article reports on the results of a survey conducted to determine why general practitioners and family planning doctors perform many more Pap smears than indicated. Approximately half of the respondents thought that smears should be taken every year, while current guidelines recommend it every three years. Additional unnecessary smears were also taken in women after menopause, after sexual intercourse, for intermenstrual bleeding, and in women with genital warts and multiple sexual partners.
Screening for squamous cervical cancer: duration of low risk after negative results of cervical cytology and its implication for screening policies.
IARC Working Group on evaluation of cervical cancer screening programmes.
Br Med J (Clin Res Ed) 1986 Sep 13;293(6548):659-64.The results of this study show that taking Pap smears every year does not confer better protection from cervical cancer than taking them every three years.
Cytologic screening for cervix cancer: each year or each 3 years?
Dubois G.
Eur J Obstet Gynecol Reprod Biol 1996 Mar;65(1):57-9.This article emphasizes that no further protection is gained from performing cervical smears every year or every two years, rather than every three years.
Cervical smears--an opportunity for disinvestment?
Spence MT, Woodman C, Collins S, Donnelly B, Desai M.
Br J Gen Pract 1996 Sep;46(410):537-8.The results of this study, conducted on 85,594 women screened for cervical cancer by Pap smear, show that, in the 30 months after the previous screening, 14,702 unnecessary smears had been performed on 12,633 of them, with no clinical indications that justified the tests.
The case for stopping cervical screening at age 50.
Cruickshank ME, Angus V, Kelly M, McPhee S, Kitchener HC.
Br J Obstet Gynaecol 1997 May;104(5):586-9.The results of this study, conducted on 23,440 women aged 50 to 60, show that the risk of cervical cancer in women older than 50 years is very low and the disease is seen almost exclusively in women who had not been adequately screened previously. The authors emphasize that little benefits can be achieved by cervical screening programs that target women who had had regular negative smears during their reproductive years, and that resources could be redirected toward more effective preventive strategies.
